Provider Demographics
NPI:1093472508
Name:HAN, YONG GYU (LAC)
Entity Type:Individual
Prefix:
First Name:YONG GYU
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:300 BALTIC CIR UNIT 322
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-2249
Mailing Address - Country:US
Mailing Address - Phone:669-529-7767
Mailing Address - Fax:
Practice Address - Street 1:1220 UNIVERSITY DR # 202B
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4262
Practice Address - Country:US
Practice Address - Phone:408-314-5472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19309171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist